IRMAA — Income-Related Monthly Adjustment Amount — is the surcharge that higher-income seniors pay on top of standard Medicare Part B and Part D premiums. Your 2026 Medicare premium is based on your 2024 tax return MAGI.
2026 IRMAA Part B Thresholds (Married Filing Jointly)
| 2024 MAGI (MFJ) | Monthly Part B Premium | Annual Extra Cost |
|---|---|---|
| $218,000 or less | $202.90 (standard) | $0 |
| $218,001–$274,000 | $284.10 | +$1,948.80/couple/yr |
| $274,001–$342,000 | $405.80 | +$4,869.60/couple/yr |
| $342,001–$410,000 | $527.50 | +$7,790.40/couple/yr |
| $410,001–$749,999 | $649.20 | +$10,711.20/couple/yr |
| $750,000 and above | $689.90 | +$11,688.00/couple/yr |
What Income Is Used for IRMAA?
IRMAA uses Modified Adjusted Gross Income (MAGI), which includes:
- Wages and self-employment income
- Traditional IRA and RMD distributions
- Pension and Social Security income
- Capital gains and dividends
- Tax-exempt interest (muni bonds)
Roth IRA withdrawals do NOT count toward IRMAA — another major advantage of Roth accounts for higher-income retirees.
Appealing an IRMAA Surcharge
IRMAA uses income from two years ago (2026 premiums use 2024 income). If your income has dropped significantly since then — due to retirement, death of a spouse, divorce, or loss of income — you can file an appeal (Form SSA-44) to use your current (lower) income instead. Many seniors successfully reduce or eliminate surcharges this way.
One dollar can cost thousands. The IRMAA tiers work like "cliffs" — if your MAGI crosses a threshold by even $1, you pay the entire surcharge for that tier. Planning income to stay just below a threshold can be worth significant savings.
Model Your IRMAA Exposure in 2026
The Tax Estimator shows your projected IRMAA tier alongside federal and state tax.